Bouts of Gout

By Dr. Bridget Brondon

Gout is quickly becoming a problem we see more and more of in our office.  We all probably know someone with gout, or if we’re really lucky, we have it ourselves (not!).  There have even been dinosaur bones discovered with gout in them, so humans are not alone!  But what is gout and how big of a problem is it?

Gout is a form of arthritis, which is why it affects the joints of our feet.  It occurs when there is an excess of uric acid in our bodies.  This can happen one of two ways: we can either produce too much uric acid or we don’t get rid of it fast enough.  Most people fall into the group that does not get rid of the uric acid fast enough.  This can be due to your regular metabolism, but there are other things that can decrease the uric acid excretion, such as certain medications (aspirin and water pills especially), alcohol intake, and certain foods, especially red meat and high fructose corn syrup.  Kidney problems can also cause this because they are the filtration system that cleans out the uric acid from the body. Dehydration can also bring on a gout attack.

When uric acid builds up in our bodies, it ends up circulating through our bloodstream and one of its favorite places to get stuck in is the joints of our feet, most commonly in the big toe joint.  Other areas of the feet often affected are the middle/arch area of the foot, where lots of very small joints are present, and in our smaller toes, but gout can occur in any joint of the body.  Other body parts that can be affected are the hands, fingers, and ankles.  

The uric acid particles form crystals within the joint, under a microscope, look very similar to sewing needles.  The inflammation from these crystals is what causes the pain.  Other symptoms include redness at the joint, swelling, warmth in the area, and A LOT of pain.  Without any treatment, in time, these crystals would naturally get broken down and absorbed into the body, but who wants to suffer through all that pain when there are medications that can help?

So, how do you know if you have gout?  The symptoms above are a very good first indication.  An aspiration of the joint can also be done where some fluid from the joint is removed with a needle and sent to the lab to look for crystals in the fluid.  Your doctor can also run a blood test to determine your uric acid levels to check if it is high.  It is important to note, however, that during the first few days of an attack, very often your uric acid level in your blood is often normal, because a lot of the uric acid has made its way to the joint and is no longer in the blood stream.  Bloodwork is usually done a month or two after an attack to determine what the baseline uric acid level in your body is when you are not undergoing an attack.  If it is naturally high, you may need long term therapy to lower it.

The most common medications that are used for treatment for an acute gout attack (when the joint is super red, swollen, warm and painful) are anti-inflammatory medications and colchicine (brand name Colcrys).  Anti-inflammatories, such as Indomethacin, Aleve, Advil, Ibuprofen, Motrin, or a Medrol dose pack (steroid pack) can help to decrease the inflammation present made by the crystals and help reduce the swelling and pain.  Colchicine works to stop the inflammation from being created in the first place.  Sometimes, these two medications are prescribed at the same time to work together to get rid of the inflammation.

It is possible to have only one gout attack in your lifetime, but it is far more likely that they may come and go throughout your life if your uric acid is not properly managed long term.  This is done with medication taken daily to help with the excretion of uric acid from the blood on a daily basis, so the levels do not rise high enough to cause a gout attack.  There are primarily 2 medications that do this: Allopurinol and Febuxostat (brand name Uloric).  Allopurinol is generally the first medication tried.  The dosage of this medication can be tweaked to fit your needs.  This medication does not work for everyone though and flares can continue to occur, or sometimes a patient can have a reaction to the drug.  Febuxostat is an alternative option in these cases.  It is also a safer drug for those patients with kidney problems.

Although gout may be a problem that only bothers you every once in a while at the beginning, it is important to seek long term treatment if you are prone to gout attacks.  The longer uric acid remains at a high level in your body, the more lasting damage you can have to your joints, even if you aren’t having any pain at the time.  Just like with osteoarthritis, even when you aren’t having symptoms, the damage to your joints is still occurring.  The same thing is true for gouty arthritis.  Over time, it also begins to take less to trigger a flare-up so they can happen more easily and more frequently.  With time, the uric acid crystals within the joint eat away at the cartilage which can cause problems with motion and inflammation in the future as well.  The crystals can over time deposit themselves permanently in the joints as well, which can cause stiff joints, bumps, and irritation.

So, what can you do to prevent a gout?  Well, once you have it, you have it.  But you can prevent attacks primarily by watching what you eat.  You can still eat all of your favorite foods, but moderation is the key.  Drink plenty of water to keep yourself hydrated and help flush your kidneys.  If you do get an attack, see your doctor right away. We want to help you start feeling better faster!
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